1982726576 NPI number — BAY SURGEONS MEDICAL GROUP

Table of content: (NPI 1982726576)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982726576 NPI number — BAY SURGEONS MEDICAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAY SURGEONS MEDICAL GROUP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982726576
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1225 MARSHALL ST
Provider Second Line Business Mailing Address:
STE 7
Provider Business Mailing Address City Name:
CRESCENT CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95531-2281
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-464-6372
Provider Business Mailing Address Fax Number:
707-464-9593

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3798 JANES RD
Provider Second Line Business Practice Location Address:
STE 6
Provider Business Practice Location Address City Name:
ARCATA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95521-4753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-822-2279
Provider Business Practice Location Address Fax Number:
707-464-9593
Provider Enumeration Date:
04/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KREMEN
Authorized Official First Name:
ALAN
Authorized Official Middle Name:
F
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
530-532-4400

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  00G569970 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00G569970 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com